title: Persistent left superior vena cava in cardiac congenital surgery.
abstract: Persistent left superior vena cava (LSVC) is a relatively frequent finding in congenital cardiac malformation. The scope of the study was to analyze the timing of diagnosis of persistent LSVC, the timing of diagnosis of associated anomalies of the coronary sinus, and the global impact on morbidity and mortality of persistent LSVC in children with congenital heart disease after cardiac surgery. Retrospective analysis of a cohort of children after cardiac surgery on bypass for congenital heart disease. Three hundred seventy-one patients were included in the study, and their median age was 2.75 years (IQR 0.65-6.63). Forty-seven children had persistent LSVC (12.7 %), and persistent LSVC was identified on echocardiography before surgery in 39 patients (83 %). In three patients (6.4 %) with persistent LSVC, significant inflow obstruction of the left ventricle developed after surgery leading to low output syndrome or secondary pulmonary hypertension. In eight patients (17 %), persistent LSVC was associated with a partially or completely unroofed coronary sinus and in two cases (4 %) with coronary sinus ostial atresia. Duration of mechanical ventilation was significantly shorter in the control group (1.2 vs. 3.0 days, p = 0.04), whereas length of stay in intensive care did not differ. Mortality was also significantly lower in the control group (2.5 vs. 10.6 %, p = 0.004). The results of study show that persistent LSVC in association with congenital cardiac malformation increases the risk of mortality in children with cardiac surgery on cardiopulmonary bypass. Recognition of a persistent LSVC and its associated anomalies is mandatory to avoid complications during or after cardiac surgery.
authors.affiliation: Pediatric Intensive Care Unit, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
authors.forename: Cristina
authors.initials: C
authors.lastname: Giuliani-Poncini
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Perez
authors.forename: Jacques
authors.initials: J
authors.lastname: Cotting
authors.forename: Michel
authors.initials: M
authors.lastname: Hurni
authors.forename: Nicole
authors.initials: N
authors.lastname: Sekarski
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Pfammatter
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Bernardo
mesh_terms: D000293:Adolescent; D002303:Cardiac Output, Low / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D002675:Child, Preschool; D054326:Coronary Sinus / Q000002:abnormalities / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D007231:Infant, Newborn; D008297:Male; D009026:Mortality; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D013557:Switzerland / Q000453:epidemiology; D054079:Vascular Malformations / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D014683:Vena Cava, Superior / Q000002:abnormalities / Q000503:physiopathology